Action oriented monitoring report Deoghar District Jharkhand

�

�

�

�

Mr. Pradeep Tandan

Consultant NRHM I

Ministry of Health and Family Welfare,

Nirman Bhavan New Delhi.

[email protected]

� ��

� �

�

�

�

�

Action oriented monitoring report

Deoghar District Jharkhand

��

� �

Executive summery��

Approach and methodology:��

Background��

Performance in last one year (2009-10)��

Qualitative report of Deoghar district��

Facility wise report��

District hospital Deoghar – Sadar��

Recommendation��

Jashidih CHC��

Sarwan CHC��

Sarath CHC��

Palajori CHC��

APHC Kusmil –��

APHC Burhai –��

HSC Rohini-��

HSC Bedia :-��

HSC Bagdaha:-��

HSC, Babhandiha:-��

�

� �

HSC, Dahua:-��

HSC, Gopibandh:-��

Annexure1 : District level monitoring format��

Annexure 2: Facility assessment format��

2.1 Sadar Hospital��

2.2 Sarwan Hospital��

2.3 Sarath Hospital��

2.4 Palajori Hospital��

2.5 Jasidih Hospital��

Annexure 3: District Profile��

Annexure 4 : Human resources in Deoghar District.��

�

� �

��

� �

Executive summery

In April 2005, Government of India launched National Rural Health Mission to make

improvements in the health system and health status of the people in the rural areas of the

country. The major goals of NRHM are to reduce the Maternal Mortality Ratio (MMR) to

100 per 100000 live births from 407, Infant Mortality Ratio (IMR) 30 from 60 and Total

Fertility Rate (TFR) 2.1 from 3.0 during the 7 years period of NRHM. In 2010, although

NRHM completed 5 years we still lag behind in achieving the targets to accomplish the goals

set for year 2012. To achieve them in next two years (by 2012) Ministry of Health and

Family Welfare identified 235 district as high focus district among total 642 district of the

country and decided to do action oriented monitoring. In the 1st phase of action oriented

monitoring 122 high focus districts have been selected. Deoghar is one of the high focused

districts (identified in 1st phase of action oriented monitoring). The visit to Deoghar district

(26th of April to 1st May) revealed certain important insights, which are presented in the

following document.

Brief Review: Deoghar district is located in north eastern part of Jharkhand state, with total

population of 1165390. The health system is existent in the form of 8 CHCs, 5 APHC and

181 HSCs and catering health services to the rural and urban populace. The district’s visit

depict that, there is a need to address following issues.

Major issues: � There is huge deficit of health

facilities (PHCs/APHCs) as compared to the requirements under IPHS.

� Lack of human resources at important positions such as district program coordinator. (DPM post vacant since 90 days)

� Improper facilities for conducting deliveries need to be addressed.

� No waste disposal mechanism existent in the health facility ( except Sadar hospital)

� Water scarcity is major problem for Jashidih CHC and other HSCs.

� The participation of village health comitties is poor, which is reflected by the scanty utilization of funds, deficient understanding of the fund utilization procedures.

� There are no sick newborn units (SNCU) in the district. There are no newborn child care equipments in the any facility of district. ANMs are not trained in newborn care skills.

� Poor maintenance and repairs of the equipments in health facilities (PHC, CHC) and laboratory is noted.

� Safety issue for new constructed CHC and PHC building.

��

� �

� District hospital: issues with burn care unit and labour room.

Situation: New buildings were constructed for the four CHCs and one APHC. Other two buildings are

in construction phase and are likely to be available in coming six months. the selection procedure for

posts of the block program managers is completed with their probable date of joining to be finalised.

It was noticed during the interaction that the health officials in Deoghar district are enthusiastic for

improvement of health services delivery. Their motivation can be maintained with periodic

encouragement from the state officials

��

� �

Approach and methodology:

The visit to Deoghar District of Jharkhand state was made from April 24th to May 1st

of 2010.The observation method with inspection approach was used in this visit for action

oriented monitoring of the high focus district Deoghar. State programme manager was not in

the state during visit, so directly went to district. A meeting was conducted with civil surgeon

and district programme unit. District programme manager was not in district from last few

months. The format was shared and discussed in the meeting and the objective of the visit

was communicated with district Programme unit. In meeting, planning for the field visit was

done with district programme unit following health institutions were covered in the field

visits:

Date Place Activity

26.04.2010 District place and Sadar

hospital

Meeting with C.S. and DPU

27.04.2010

Jashidih (CHC)

Kusmil (APHC)

Burhai (APHC)

Rohini (HSC)

Meeting with MOs and SN

ANM

28.04.2010

Palajori (CHC)

Bedia (HSC )

Bagdaha (HSC)

Babhandiha ( HSC)

Meeting With ANM, MPW ,

MO, ASHA/SAHIYYA and

VHSCs

29.04.2010

Sarwan (CHC)

Dahua (HSC)

Sarath (CHC)

Gopibandh (HSC)

Meeting With ANM, MPW ,

MO, ASHA/SAHIYYA

Assessment of the health facility was done based on the monitoring format by inspecting every part

of the health institution. The format was shared with the Medical Officers in detail to communicate

the expected standards and scoring pattern. With the medical officers, ANM, SAHIYYA and RKS

and VHSC (GKS) members discuss the different issue related to health services at the visited

facilities.

��

� �

Background

Deoghar district was formed in 1983. Earlier it was a sub-division of Santhal Pargana

district. It is located in north-eastern Jharkhand and is surrounded by Dumka [North-East],

Rajmahal and Bhagalpur; [North-West Munger] ; Hazaribag [in the West] and Giridih districts [and

in the South].

The district head quarter is located in Deoghar town. Man and Munda were among the primitives of

this area.

Table 1: Major health indicators of Deoghar

Indicator Deoghar Jharkhand

CBR 28.4 26.8

CDR - 7.5

IMR 67 50

MMR 371 371

TFR 2.71 2.71

(Source: District health action plan, Deoghar 2009)

��

� �

Table 2: Major indicators in district Deoghar

Indicators Deoghar District Jharkhand State

Population (in lakhs) 11.65 265.4

Average annual exponential growth rate 2.44 2.31

Population Density (per sq.kms.) 468 338

Sex ratio 914 941

Percent urban 13.8 22.24

% Population person 0 to 6 years:

Person

Male

Female

Percentage of literate population

Male

Female

18.9

220003

111492

108511

50.6

66.9

32.3

4556827

2522036

2434751

43.71

55.07

31.62

Source: Census,2001

The population density, annual exponential growth rate, of the district is higher as compared to the

state. However the district has lower sex ratio, as compared to the state. The district is reported to have

literacy rate of 50.6 percent (66.9 % males & 32.3 % females). About 12.8 percent of the population of the

district lives in urban areas in contrast to 22.24 percent in the state.

�

� �

Table 3Total number of block Panchayats and Villages

Sl. No. Name of Block Total No. of Gram

Panchayats Total No. of

Villages

1 Deoghar 29 348

2 Mohanpur 29 381

3 Sarwan 26 458

4 Devipur 17 214

5 Madhupur 24 256

6 Karoan 24 206

7 Sarathh 27 343

8 Palajori 17 265

Total 193 2471

The block wise distribution of population in the Deoghar district. As clear from the table, the

block Deoghar is the most populous among all the blocks. Out of these 8 blocks, the blocks viz.

Deoghar, Mohanpur, Sarwan, Devipur, Madhupur, Karoan, Sarath and Palajori have been designated

as non tribal blocks.

�

��

� �

Table 4: Scheduled cast and scheduled tribe population in Deoghar district

No Block name

Area

(In Sq.

kms.)

Population Percentage of

Population (census 2001)

Total SC ST SC ST

1 Deoghar 31778.7

8 256063 36411 10316 14.2 4.0

2 Mohanpur 36186.8

4 143479 20869 14854 14.5 10.4

3 Sarwan 308.7 128938 16841 10814 13.1 8.4

4 Devipur 400.0 84658 11005 9347 13.0 11.0

5 Madhupur 30836.9

8 167773 22023 22842 13.1 13.6

6 Karoan 25841.1

0 119497 10405 18811 8.7 15.7

7 Sarathh 8025935

7 136950 19772 19022 14.4 13.9

8 Palajori 3029.83 128032 9537 36711 7.4 28.7

Total 2479 1165390 146863 142717 12.60 12.24

��

� �

Performance in last one year (2009-10)

The performance of this district is described from the progress report of April 2009 – March 2010.

It can be easily noted that the districts have performed well in some areas (fund utilization of untied

fund of ANM’s, family planning) however; it has underperformed in some areas (immunization,

Antenatal care).

1. The immunization rate in the district was noted to be 71 % and it ranked 19th among all 24

district.

2. In maternal health, only 67% ANC registration was achieved during 2009-2010 period and it

was 17th rank. Only 38% achievement in all 3 ANC coverage (19th rank) in Deoghar district

.29% achievement in institutional delivery (13th rank) in the period of 2009-2010 by Deoghar

district.

3. In family planning (Tubectomy) Deoghar district was 2nd in Jharkhand with achievement of

114%. 27% achievement in IUD insertion and rank was 17th in state.

4. Deoghar district was 2nd in Jharkhand in achievement of cataract operation with 161% of

achievement. 65% of RCH fund of NRHM was utilized by district. 86% of untied fund of HSC

was utilized in Deoghar district. Only 15% untied fund of VHC was utilized in district during

period of 2009-2010. 69% fund of hospital management society was utilized by Deoghar

district. (Based on the progress report of State programme unit)

��

� �

Qualitative report of Deoghar district

As per existing norms one Health Sub centre [HSC] is established for every 5000

population ( tribal areas=3000), one primary health centre (PHC) for every 30,000 population(

tribal area 20,000) one CHC for every 1, 20,000 population (tribal areas =80,000).

In Deoghar district, 181 Health Sub centers, 5 Additional Primary Health Centers, 8

Community health centre, 1 FRUs and One District Hospital are functioning.

Blocks CHCs PHCs HSCs

Populatio

n

Existin

g

(In

No.)

Need

(In No.)

Existin

g

(In

No.)

Need

(In No.)

Existin

g

(In

No.)

Need

(In No.)

covered

Deoghar 256063 1 1 2 8 17 31

Mohanpur 143479 1 1 0 5 31 31

Sarwan 128938 1 1 1 5 29 29

Devipur 84658 1 1 0 5 11 21

Madhupur 167773 1 1 1 7 13 34

Karoan 119497 1 1 1 5 21 24

Sarathh 136950 1 1 0 5 30 30

Palajori 128032 1 1 0 5 29 29

Total 1165390 8 8 5 45 181 229

Above table reveals that as per the population norms still 40 more PHCs required to

be setup. As in case of HSCs, total HSCs are required 229. Deoghar district has 181 existing

HSCs. Therefore, Deoghar district needs 48 more HSCs.

��

� �

HSCs :-

Health Sub Centres are mostly maintained by one ANM’s in the district. ANM’s are

providing OPD’s in the morning and regular community visit in days. They dispense family

planning, ANC commodities and assist in routine immunization and Polio immunization

programme. In Deoghar district ANM are providing facility of normal delivery in sub centre.

The most importunate issue was that in all sub centres, labour board was rusted and bare

board was using for delivery.

Table 5: Gap between the existent and needed facility

APHCs –

In district there are 5 APHCs. During visit one of the APHCs was shifting to new

building and new building is prepared for another APHC Kusmil. 3 APHCs are in rent

building. In the Deoghar district APHC only provides OPD Services. There are no

equipments and facilities in APHC’s for conducting deliveries. Thus, APHC is even though

equivalent to PHC’s do not conduct institutional deliveries. 45 PHCs are more required in

district according to IPHS norms but only 5 PHCs are in the district there is huge gap in this

facility.

�

��

��

��

��

��

� ��

��

��

��

� �

BPHCs –

There are 8 CHCs/ BPHCs in the Deoghar district. Newly constructed building is

ready for 6 CHCs. CHCs are providing 24x 7 services. Presently none of the CHCs is

providing specialist services. Cold storage for vaccines are present in CHCs and they are

properly maintaining the cold chain. Some CHCs MS are posted (like CHC Palajori ) but

due to lack of infrastructure they are not able to provide specialist services. New buildings

are good and after shifting, we can hope for good services.

Sadar Hospital/ District hospital :-

There is one Sadar and one referral hospital in the district. The Sadar hospital is

functioning but there is quite a lot of scope and need for improvement. Ultrasound machine

is present in Sadar hospital but lack of radiologist or trained person presently machine is

useless. Thus there is need to ensure that radiologist are employed or provide training to

someone at the earliest. Burn ward is open in district hospital it looks like more prone to

increase the complication rather than improve the condition of the patient.

Maternal and Child Health:-

In last one-year, (2009-10) total ANC registration was 71% against the targeted

value and Deoghar district was 16th rank in Jharkhand district. Achievement for all 3 ANC

check up was only 38% against targeted value and 19th in Jharkhand. Institutional delivery in

Deoghar district was only 29 % and 13th among 24 district of Jharkhand. Achievement of full

immunization was 71% in Deoghar district during the period of 2009-10 and it was 19th rank

in Jharkhand district.

In the interaction with ANM, Sahiyya it was revealed that focus of anti natal care

(ANC) was restricted to the distribution of iron and folic acid tablets and T.T injections;

however they were alarmingly unaware of the critical parts such as measurement of blood

pressure and its importance from the maternal health point of view. Secondly substantial

number of health workers were not able to provide comprehensive information on nutrition

related issues in the pregnant women. Going further it is noticed that, although women

receive iron supplementation and T.T. injection they hardly receive complete ANC check-up

��

� �

by doctors. ( reflected by last year’s performance where 1st ANC registration was 71% and it

was drop down in only 38% in all 3 ANC check up)

To our notice it was seen that, those health functionaries who are trained in ANC cannot

sustain the application of knowledge due to lack of instruments at the PHC level. ( facilities

for Haemoglobin testing and B.P. of pregnant women is not available at facilities below the

CHC level).

In the case of intra natal care it was found that, due to JSY the numbers of women

undergoing institutional deliveries are on the rise. All the facilities are using the bare labour

board, most of them are rusted, and lack of quality in institutional delivery may be deterrent

to safe delivery. Proper labour board with mackintosh and hygienic condition is required in

all the institution in the district for safe institutional delivery.

During interaction with Shiyya and ANM it was found that they are doing PNC visits in

the community. 24 houses stay was maintaining in the Sadar hoapital and CHCs but lacking

in HSCs.

Routine immunization was conducting on Thursday and Saturday in district. Shiyyas are

also helping in routine immunization in district. There is no sick new born unites in the

district. There is no “child care skill” trained ANM in the district. There are no newborn child

care equipments in the any facility of district.

Home delivery

Home delivery without SBA was 10.83% in district in the period of 2009-10 and home

delivery with SBA was 7.46%. There is no tracking system in district for home delivery and

unreported delivery. Sahiyya is appointed according to habitation; it will be easy to track the

pregnant woman and also home delivery through Sahiyya . However, there is needed to make

proper tracking system for home delivery.

Janani Suraksha Yojana

��

� �

JSY is working well in the district. There is no backlog before March all the payments

are clear. In Deoghar district, they are providing 500 INR for home deliveries but this is only

for BPL families. Under JSY there is package of 2000 in district in which 1400 for pregnant

woman, 150 for Sahiyya , 200 again for Sahiyya after completion of BCG vaccine and 250

for travelling of pregnant woman.

Interactions with Sahiyya ,ANM and beneficiaries it was revealed that Sahiyya spend a

lot of money and energy traveling back and forth to the hospitals for securing payments. It

was also found that corruption involved in JSY, Sahiyya’s are not getting there incentives

properly some hospital staffs are demanded share in the incentives.

Village Health and Nutrition Day

In the district total 11948 Village Health and Nutrition Days were conducted between

January 09 to March 10. Sahiyya ANM and Anganwadi workers are helping to conduct the

Village Health and Nutrition day. Every Thursday is fixed for the Village Health and

Nutrition Day and routine immunization are conduct from same centre. ANM are providing

the Immunization services, Anganwadi worker are providing the nutrition support and

Sahiyya provides support to both of them.

Sahiyya/ ASHA –

2957 Sahiyya are selected in the district. Among 2957 Sahiyya 1389 were trained up to

module 4, 2561 were trained up to module 3 , 2764 were trained up to module 2 and 2688

were trained in only 1st module. During visit discussion was done with total 7 Sahiyya from

different village in different issues. It was revealed in discussion that they are unsatisfied

with the incentives. It was found that there were lacks of motivation in some of the Sahiyya

to work for community. It was found that all the drugs of drug kites of 2 Sahiyya were expiry

dated. Interacted all 7 Sahiyya were trained up 4th module and it was found that they were

aware about the concept of all the 4 module training.Shiyyas are providing support in routine

immunization, JSY programme and other national health programme . But there is need to

increase the motivation among Shiyya and strengthen in Shiyya programme in the district.

��

� �

Village Health Committees:-

In Deoghar district, Village Health and Sanitation committee is known as Village

Health Committees. In the period of (2009 -10) only 15% untied fund was utilized by the

committees. During interaction, it was revealed that committees were aware about 1000

fund but unaware about “how to use and where to use the fund”. Total 2277 Village Health

Committees are functional in the district but there is need to empower the committees for

the proper functioning.

Hospital management society/ RKS: -

In Deoghar district during period of (2009-10) 69 % fund of hospital management

society was utilized. In interaction, it was revealed that there is a lot of fear and confusion

among the MOIC’s about the purpose of utilization. However, they are interested to utilize

the fund and they strongly feel the need of some short of workshop or training to

understand the utilization process and purpose .Some are using it in proper way (Palajori

CHC use the fund to outsource Security guard and one group D staff).

Bio medical waste management:-

There is no bio medical waste management in the district health institutions except

Sadar hospital .During visit it was found that none of the hospital were using any dust bin or

colour coded buckets for biomedical waste. Needles were spread in Palajori CHC, bio

medical waste were spread in Sarath CHC and same condition was in the Jashidih CHC.

Needle cutters are given to every institution but none of the institutions were using it.

Human resource Issues: -

The DPM position is vacant since last 3 month and BPM in all block of district are also

not appointed in the blocks, hence monitoring and supervision of the programme

implementation and further organizing and planning processes at the DPMU are

suffering.36%( 22/60) of medical officers are vacant in the district ( annexure 4 ). There is

also an acute shortage of Paramedics in the district (Ex. 77.27% post of Formasist ,64.70 post

of lab technician. 57% ophthalmic assistant ,71.42% of male health worker are vacant in the

district) . There is no Radiographer in any CHCs. Only seven CHCs have 1 compounder.

��

� �

There should be at least 2 compounders in each of the CHCs, at CHC level, according to the

staffing norms for CHCs. Vacant post of ANM and SN in the district are also major issue.

Issue with newly constructed buildings:-

There is no platform in the laboratory rooms in the newly constructed

building of the Jashidih CHC and APHC Burai. There is need of security of the newly

contracted building (water pump of newly constructed Kusmil APHCs was stolen by some

anti social aliment)

Facility wise report

District hospital Deoghar – Sadar

Sadar hospital Deoghar is present in the centre of the district headquarter. It is well connected

and accessible to the parts of district. It is a 100-bed ISO certified hospital with 24 X 7

maternal cares. However, there are some impotent issue in the Sadar hospital.

Patient load in district hospital

��

� �

�

��

Graph shows that OPD load was increased in month of July and February, we can

plan the preventive measures and alter the system according to previous history of

OPD , IPD and previous emergency patient load

Facility assessment

Sadar hospital scored 82 out of 125 based on the facility assessment format.

��

��

��

��

��

��

��

�

��

��

��

��

�

��

��

��

��

��

��

��

��

��!"

#$��%

��

��

��%�

#��

��$��& ��

' !�(��

)(*�& ��

+�!�& ��

��(�$��%��,(��-��. ��

��(�+�!�& ��

' �+�

/�+

0& ��!�

��

�

��

Sadar hospital Deoghar scored poor in bio medical west management and good in service out

sourced and Janani suraksha youjana , but there are many issues in Sadar hospital some of

them are

Gap statements

1) Number of specialists available at the district hospital is far less than the sanctioned

posts as per IPHS norms leading to unavailability of OPD services for respective

Specialities.

2) The IPD lacks the essential equipments needed for conducting required procedures as

desired at district hospital.

3) Respective doctors do not visit patients in the wards regularly.

4) Number of staff nurses in the district hospital is for less than sanctioned post as per

IPHS norms.

��

��

��

��

��

��

��

��

��

��

��

��

��

��

� �

5) Emergency OT is not available to help and manage the emergency cases as required

under the IPHS norms.

6) The OT lacks some essential equipment needed for conducting required procedures

and surgeries as desired at district hospital.

7) Maintenance and calibration of equipments are not done regularly, which affects the

accuracy of the result as well the life of the equipments.

8) A qualified radiologist is not available in the hospital.

9) Crowding and chaos at the entrance of the hospital building and the OPD counter due

to lack of space

10) Basic facility like toilets drinking water, telephones etc are sufficiently not available

at the OPD for public conveniences.

11) Wheel chair is not available in the OPD and emergency

12) Patient’s visitors lead to unnecessary crowding in the wads at all hours. Thus

hampering the services of the wads .Security needs to be strengthened in the wards.

13) Basic patient facilities like bedside lockers, chair, drinking water etc are not

available in the wards.

14) Emergency OT is not available to help and manage the emergency cases as required

under the IPHS norms.

15) Number of paramedical staff in the district hospital is far less than sanctioned post as

per IPHS norms, thereby affecting patient care across all service areas.

16) The X ray department does not meet the AERB guidelines

17) The X ray machine has never been calibrated

18) The Laboratory test are performed in the waiting area due to lack of spaces .

19) The sterilization of the equipment are not full proof due to the non availability of

sterilization mark strips.

20) The store department in the hospital has limited space.

��

� �

21) Labour room is in 1 st floor. Left and slop is not present. Stretchers are using to shift

the patient before and after labour to ground floor.

22) Burn unit is open, crowd and no cooling facility in burn unit.

The interaction with incharge hospital superintendent revealed some impotent issue that

1) Security and housekeeping both needs to be strengthen

2) Proper water supply and electricity are two major problem in district hospital

3) No causality section

4) O.T. staff is anther impotent issue , number of O.T staff is far less than sanctioned

post as per IPHS norms ( no O.T. assistant, and dresser)

5) Ultrasound is closed due to unavailability of proper-trained person.

.

Recommendation

1) There is need to shift the labour room in ground floor or make some proper and safe

arrangement to shift the pregnant woman to 1 floor .

2) Due to high patient load and according to IPHS norms there is need of more doctors

in the hospital.

3) There is a need to set up neonatal care unit in the district hospital.

4) Ultrasound machine is present in the district hospital, so hospital and district

authority should think to send someone for training.

Jashidih CHC

Jasihdih CHC was visited on 27th April 2010. CHC Jashidih catering the population

of 304466 approximate (projected population based on census 2001). It has 17 HSC.

CHC Jashidih has two medical officers both are MBBS doctor .6 other medical

officers of additional PHC of Jashidih providing their services to CHC. New building

��

is constructed and local administration is planning to shift it within a month. It is

upgraded as CHC from PHC in session 2009-2010.

Facility assessment –

�

��

CHC Jashidih scored 37 out of 125 based on the facility assessment format.

Infrastructure is very poor. Service availability is also very poor. CHC scored well in

JSY, recodes and reports. During visit, it was found that no IPD patient was admitted.

Maintenance and calibration of equipments are not done regularly and properly.

Labour wards need to improve. There was not any functional O.T. and condemned

article stored in wards.

Issue in new constructed building – laboratory room has no platform and lack of

proper lighting. Lack of proper water supply is another issue for the new constructed

building.

Recommendations

1) According to local authority CHC Jashidih will shift in new building in next 2

��

��

��

��

��

��

��

��

��

��

��

month, but before it hospital and district administration with district programme

unit should plan properly for Bio medical waste management, physical facility for

laboratory and out sourced facilities like housekeeping and security.

Sarwan CHC

Sarwan CHC was visited on 29th April 2010. It is on the district road. CHC Sarwan

cater health services to the population of 153311 approximate (projected population

based on census 2001). It has 31 HSC. One medical officer is in CHC Sarwan one

MBBS and other is contractual AYHUS doctor. CHC hospital administration also

taking services in CHC from 2 other medical doctors of it’s additional PHC. CHC

Sarwan is upgraded as CHC from PHC in session 2009-2010. New building is

constructed and local administration is planning to shift it within a month.

Facility assessment

�

��

��

��

��

��

��

��

��

��

��

��

��

�

��

��

��

��

��

��

��

��

CHC Sarwan scored 64 out of 125 based on the facility assessment format.CHC

Sarwan cored poor in infrastructure

During visit it was found that there was no dressing table. Condemned articles are

stored in labour room and O.T. Laboratory was well maintained but labour room and

O.T need to improvement. Condition of toilet was very poor. No patient was admitted

in IPD. Cold chain for vaccine was proper maintained. Conditions of cots were bad, it

was rusted and mattresses were worn.

During interaction with medical officer it was revealed that they are not proper aware

about utilization of untied funds. It was also found that doctors are keen to improve

the hospital services.

�

�� !��""#

Above graph shows that in last year OPD Load was more in the month of July and

IPD load wad high in month of February. We can plan for proper management in

coming month of July in the CHC on the basis of previous OPD recodes.

Recommendations

According to local authority CHC Sarwan will shift in new building in next 2

month, but before it hospital and district administration with district programme unit

��

should plan properly for Bio medical waste management and service delivery pattern

according to the present weakness.

Sarath CHC

Sarath CHC is located by the side of district road. CHC Sarath is upgraded as CHC

from PHC in 2009 -2010 session. New building is constructed and local

administration is planning to shift it within a month. 2 MBBS and one gynaecologist

are providing services to CHC Sarath.

Facility assessment

�

Graph 6 Facility assessment Sarath CHC

��

��

��

��

��

��

��

��

��

��

��

�

��

��

��

��

��

��

��

��

��

� �

CHC Sarath scored 58 out of 125 based on the facility assessment format.

Infrastructure and Bio medical Waste management is very poor in the CHC .During

visit it was found the cold chain maintenance for vaccine was proper. They put the

name of centre and address in vaccine box for proper identification and which is a

good practice. There was no dressing room and bio medical waste was spread near

the dressing table .In labour table was bare and it was common practice in area to use

the bare table for labour. Window glasses were broken and during interaction with

medical office inchage it was found that security was a major concern specially at

night .

Recommendations

According to local authority CHC Sarath will shift in new building in next 2 month,

but before it hospital and district administration with district programme unit should

plan properly for Bio medical waste management and service delivery pattern


Palajori CHC

Palajori CHC is located by the side of district road. CHC Palajori is upgraded as CHC

from PHC in 2009 -2010 session. New building is in construction phase. 2 MBBS and

one general surgeon are providing services to CHC. CHC Cater the health services to

the population of 152234 approximate (projected population based on census 2001).

It has 29 HSC.

Facility assessment

��

�

��$�� %��

CHC Palajori scored 69 out of 125 based on facility assessment format.CHC Palajori

scored poor in infrastructure and services availability . Equipments, supplies and

Function of Janani Suraksha Yojana was good in CHC Palajori . One aya and security

guard were out sourced by the fund of hospital management society. Labour was well

maintained but O.T. was not in functional condition. Bio medical waste was major

issue in the hospital, needle cutter was in working condition but not used by

employees, and they store the needle in ordinary carton. Deep burial pit was available

but employees are not using it. During visit this issue was bring to notice of medical

officer inchage and he took immediate action on this issue.

Recommendations

According to local authority CHC Palajori will shift in new building in next 2 month,

but before it hospital and district administration with district programme unit should

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

��

�� %��

��

� �

plan properly for Bio medical waste management and service delivery pattern


APHC Kusmil –

APHC visited on 27th April 2010. Two medical doctors are providing services in

APHS. One in MBBS and other is paediatrician. Infrastructure is huge problem in

APHC. New building is constructed but APHC yet to be shifted local authority is

planning to shift it within a month. During interaction it was revealed that security is

a major concern in APHC (one motor pump was stolen and glasses of newly

constructed building was broken by antisocial aliments). Only OPD service is

providing in the centre.

APHC Burhai –

APHC visited on 27th April 2010. On the day of visit APHC was shifting to new

building. 2 medical officers are currently providing service in APHC among then one

is MD medicine and other medical officer is general surgeon. There is lack of

paramedical staff in the APHC. Only OPD service is providing in the APHC.

HSC Rohini-

HSC Rohini was visited on 27th April 2010.HSC was running in newly constructed

government building. During visit ANM was providing the OPD services to

community. During visit normal delivery facility was not state. ANM is providing the

scheduled immunization to children on Thursday and Saturday. ANM also visits the

community and providing different services and conduction health education activity.

Recodes was properly maintained by ANM.

HSC Bedia :-

HSC Bedia was visited on 28th April 2010. HSC was running in a kaccha house and

condition was not good. During visit ANM was providing the OPD services to

community for common illness. ANM provides the family planning immunization

��

� �

and National health programme services. ANM also stared the adolescent health

activity for girls in centre.

HSC Bagdaha:-

SHC Bagdaha was visited on 28th April 2010. ANM’s quarter was in the sub center.

Open needles was not disposed and it was spread in the centre. There was no store

room in the Sub Centre and some drugs with expire dates was on the table of ANM.

During interaction with ANM it was revealed that AMN visits community every day

from 4:30 pm to 6 pm and providing different health services.

HSC, Babhandiha:-

SHC Babhandiha was visited on 28th April 2010.During visit it was closed. With

interaction to community it was found that water is a major issue in the sub centre.

Villages told during interaction that ANM visits community regularly and providing

different health services to the community

HSC, Dahua:-

SHC Dahua was visited on 29th April 2010. SHC was well maintained. Available

Drug list was display on board. Labour room was clean but bare table was using for

the delivery.

HSC, Gopibandh:-

SHC Gopibandh was visited on 29th April 2010. During visit ANM was providing

OPD services. One pregnant lady was in labour room but here also bare table was

using for the delivery. Condition of the building was poor. Common equipment used

for labour was not maintained properly.

��

� �

Recommendation for district

� Fill up the post of district programme manger so that ensure the processes of

planning, organizing and monitoring are carried out in the district.

� Stop the use of bare labor board for delivery in all the health facility in district and

provide the mackintosh to all the health facilities

� IMNCI tanning should be taken up as soon as possible.

� Cleanliness and hygiene in the health facilities to ensure infection control and not to

harm the patients should be the objective.

� No waste disposal mechanism existent in the district there is needed to develop

proper waste disposal mechanism in the district.

� All CHC are soon shifting to the new building, district health administration and

programme management unit should plane properly for shifting and analysis the

present weakness to overcome it.

� Sahhiya workers are doing well in district however there is lack of motivation

among the Sahiyya in the district .District programme unit should plane for some

motivational programme for them. District health administration and programme

management unit ensure the Sahhiya as bridge between the community and health

system not as assistant to the ANM’s.

� VHC’s need to be empower in district to play active part in improvement of the

health of community and properly utilization of the untied fund.

��

� �

Annexure1: District level monitoring format

Monitoring format for Consultants visiting High Focus Districts – Final

1. Name of consultant ------------------------------------Pradeep Tandan

2. Place of visit and date ----------------------------------Deoghar (24th April to 1 May )

Progress against Monitorable indicators in District (wherever applicable)

Activity / Measurable indicator Achievement

in/up to 2009-10

Target

(Cumulative)

in/up to 2010-

2011

Addition

during the

year

I Monitoring Progress Against Standards:

A Maternal Health Outputs

1 Institutional Deliveries

11525 Data is not

available

Data is not

available

2 24X7 Facilities (includes PHC, CHC, SDH

minus FRUs)

CHC 8

PHC 5

FRUs 1

Data is not

available

Data is not

available

�

� �

3 Functional First Referral Units (including

CHC, SDH, DH)

1 ( SDH) Data is not

available

Data is not

available

4 Functional Sub Centres

181 NA NA

B Child health

5 Sick New Born Units (SNCU)

0 NA NA

6 Stabilization Units in CHCs/ BPHCs NA NA NA

7 Full Immunization

100 71.46

C Population Stabilisation:

8 Male Sterilization

1200 65 NA

9 Female Sterilization

6400 7320 NA

��

� �

10 No. of IUD insertions

11113 3038 NA

D Disease Control :

11 Case Detection Rate of TB among new

sputum positive patients

55% NA NA

12 Treatment Success Rate among new sputum

positive patients initiated on DOTS

92% NA NA

13 ABER for malaria 8.95% NA NA

14 API for malaria 0.2/1000

15 No. of Reconstructive surgeries performed

under NLEP

0

16 Annual New Case Detection Rate for

Leprosy

16.8%

17 Cataract Surgeries performed 3400 5466

II Human Resource

18 Appointment of ANMs

302 302

19 Appointment of staff nurses

14 14

20 Percent of ANMs trained as Skilled Birth

Attendant

240

��

� �

21 Doctors trained on EmoC

22 Doctors trained on LSAS

23 Doctors trained in NSV/ Conventional

vasectomy

24 Doctors trained in Abdominal Tubectomy

(Minilap)

25 Doctors trained in Laproscopic Tubectomy

26 Personnel trained in IMNCI 161 1794

III Communitisation Processes.

27 Functional VHSCs 2277 1772

28 ASHAs completed four modules of training 2957 1122

29 ASHAs with Drug kits 2957 2623

30 Percent expenditure of NRHM funds through

Non Governmental organizations

19%

31 Percentage Districts having community 31%

��

� �

monitoring system in place

IV Flexible Financing

32 Percent utilization of untied grants

V Improved Management:

33 Percent districts uploading timely HMIS Data

and confirming

Yes

34 Tracking of pregnant mothers and children

Yes

35 Computerisation of HMIS Yes

36 Cold Chain Management Yes

37 Procurement System

VI

38 Functional Mobile Medical Units 3

39 Poor performing districts sub-plan made with

targets, and quarterly review shows progress

40 Difficult, Most Difficult, inaccessible area

thrust in provision of infrastructure and

human resources.

Difficult 46

SERVICE GUARANTEE MONITORING PARAMETERS

��

� �

• PARAMETER BASELINE PROGRESS

IN LAST

QUARTER (

SPECIFY

QUARTER )

PROGRESS

IN QUARTER

VISITED (

SPECIFY

QUARTER )

• Percentage of VHND conducted versus

Village Health and Nutrition Days planned

in the District Percentage of VHND

conducted versus Village Health and

Nutrition Days planned in the District

11948

(Jan 09 to

March 10)

• Deliveries conducted per skilled Birth

Attendant per month in the block. Facility

wise performance may be monitored at the

district level. Increase in the delivery / OP

performance may be monitored

NA

• Outpatients examined per doctor per day in

District

NA

• Number of caesarean sections performed in

the district hospital out of total number of

deliveries conducted

24

• Number of caesareans performed per

obstetrician in the district hospital

5

��

� �

• Bed occupancy rate for block PHC

• Bed occupancy rate of district hospital 87.1%

• Percentage of mobile medical camp

conducted against number planned

NA NA NA

• Average number of OP cases seen per day by

the mobile team

NA NA NA

• Percentage of blood smears for Malaria

Parasite taken out of total Out Patient ( 10%

of new OPD)

4.6% NA NA

• Percentage of sputum smears collected for

AFB out of total Out Patient ( 2% of adult

OPD)

5% NA NA

• Number of PHC/SHC constructions

completed against planned

NA NA NA

• Number of maternal complications treated

against total number of deliveries

10 NA NA

• Percentage of drugs available for Block NA NA NA

�

� �

PHC per day against the expected number of

drugs

• Percentage of JSY payment pending out of

total deliveries in the District

0( March)

RCH MONITORING PARAMETERS

Total Population: 1345137 (source 2009-10)

CBR: 26 (SRS 2008 State)

Expected Deliveries per year: 35503(2009-10)

Total reported deliveries: 18086

Institutional deliveries: 11,588

Home non-SBA deliveries: 3845

Home SBA deliveries 2652

Total unreported deliveries: 20,644 probably home- unattended- but also some pvt

sector unreported.

LEVEL OF CARE / FACILITIES:

Level 3

(CEmONC)

Level - 2

(BEmONC)

Level 1

Home & SBA

Total

Govt. Pvt. Govt. Pvt.

No of facilities

functional as of 1 4

7 out of 8

CHC and 1 5

20/181 HSCs

0/5 APHCs

DH-1

Referral-1

��

� �

Level 3

(CEmONC)

Level - 2

(BEmONC)

Level 1

Home & SBA

Total


now (name in

annexure)

referral( out of

8 CHCs one is

not conducting

deliveries )

CHC-8

APHC-5

HSCs -181

Total Nos of

reported

deliveries in 2009-

10

4810 3 6,278 0

500 11,588

Institutional

deliveries

+Home non

SBA:

3845+Home

SBA

2652=18,085

deliveries

Normal 4785 6278 500 11563

C- sections 25 4 0 0

Other

Complicated 505

Target for 2010-

11: total deliveries 6000

150

0 9000

2000 18100

Total no of

facilities

/providers that

would be

providing this

level of care

1 DH 5

7 new CHCs

construction in

8 existing

CHCs +5

APHCs

8

20 HSCs

3 APHCs

Expected normal 4500 100

0 8200 450

900 at SHCs +

1100 at home

SBA

15300

��

� �

Level 3

(CEmONC)

Level - 2

(BEmONC)

Level 1

Home & SBA

Total


Expected

complicated 1500 500 800 150

0 2700

Target for 2011-

12 NA NA NA

NA

Total no of

facilities

/providers that

would be

providing this

level of care

NA NA NA NA

NA NA

Expected normal NA NA NA NA NA NA

Expected

complicated NA NA NA

NA NA

Process Targets NA NA NA NA NA

On HR – numbers

of doctors,

specialists and

nurses

2 Surgeon

3Gynaecologi

st

1 anaesthetic

15 SN

9

Gynaecologist

8 SNs exists +

4 SNs to add

On training

SBA 20

Trained SNs +

4 Additional to

be trained

2 MOs for

EmOC to be

trained

220 ANMs

trained in SBA

Targeted ANM

training in SBA

83

Targeted ANM

training in

��

� �

Level 3

(CEmONC)

Level - 2

(BEmONC)

Level 1

Home & SBA

Total


2 MOs for

LSAS to be

trained

2 MOs in

IMNCI trained

, 5 more to be

Trained

2 doctors

trained in NSV

existing 1

proposed

IMNCI 50

On supervision

1 PHN

1 Certified

supervisor

On blood

provision 2 blood banks

On referral

transport

On Infrastructure

New buildings

300 bed DH

under

construction

7CHC +5 PHC

+ 22HSCs

under

construction

Renovation

On newborn child

care equipment

1 SNCU

proposed

3 NSU

proposed 4

��

� �

Level 3

(CEmONC)

Level - 2

(BEmONC)

Level 1

Home & SBA

Total


New born

corner

certification 1 DH ISO

certified

3 proposed for

FFHI

certification

Current level Aim to reach…

Home based Newborn and Sick

child care

HBNC ToT is going on

SNCU – Nil

Aim to reach 12 days of training

this year ; subject to gaps supported

by GOI / other sources

ANM skills in child care IMNCI ToT completed ;

training would be taken in

2010-11

150 ANM in IMNCI

Line listing of pregnant women

and children below 2

Ongoing To list all pregnancies

Facilitation for ASHAs/mothers

at facility.

Nil Proposed in 2010-11

NGO involvement 5 NGO Maintain in current level

Family Planning services

Tubectomy FDS – Nil

Tubectomy – 7200( Feb

2010)

FDS proposed in DH AND 2 CHC

15 cases per week x 50 weeks x 3

centres = 2250

NSV FDS- Nil FDS proposed in DH AND 2 CHC

3 cases per week x 50 weeks 3

��

� �

NSV 65 (Feb 2010) centres = 450

MTP At FRUs (315) To introduce MVA services

��

� �

Major Observations with regard to facilities visited (Please attach Facility Monitoring

Report as per Annexure2)

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

____________________________________________________________________

___________________________________________________________

Major discussion points with ASHA / Beneficiaries /Panchayat members at the village

level

a) Water scarcity

b) Drug availability

c) Utilization of Untied funds

d) Institutional delivery at HSC

e) Honorarium of JSY and Immunization

Major discussion points with ANM/LHV/MO at the facility level

a) Human resource problem

b) Utilization of untied fund

c) Bio Medical waste management

d) Common disease pattern in OPD

e) Drug availability

��

� �

f) Community visit by ANM

g) Facilities in PHC and CHC

Major Observations

a) Proper drinking water facility is not available in Jasidih CHC , Sarwan

CHC,

Sarat CHC and most of the HSC.

b) Lack of Bio medical waste management in the entire visited place.

c) Unhygienic condition of the labour room in Jashidh , Sarwan and Sarat

CHC. (In district Hospital labour room is in 1st floor without any lift and

Slop).

d) Lack of proper dressing table and material

e) There were no seating arrangements in the OPD area even in District

hospital.

F) Unsafe practice in Laboratories

g) Safety issue for new constructed CHC and PHC building

��

� �

Major actionable points

i. Bio Medical waste management

ii. Hygienic labour room

iii. Proper dressing and examination table

iv. Condemned article free wards

v. Drinking water facility in PHC/ APHC / CHC

vi. District hospital burn Unit management (it was open and full with

relatives during visit)

vii. Seating arrangement for patient in OPD area

viii. Proper training/ facilitation to use untied fund (also include MO)

Action taken by consultant on the monitoring feedback

a) Biomedical waste management suggestion

b) Suggested some safety measures in laboratory use

c) Suggestion to display the drug availability and doctor’s name.

��

� �

d) Suggestion to use untied fund (MO and VHSC and Sahiyya/ASHA)

e) Suggestion for regular community visit (for ANM )

f) Suggestion for labour room (for cleanness and Hygienic practise) ( in district/

Sadar hospital it must be shift on ground floor)

Pradeep Tandan

(Signature and Name of Consultant with Date)

��

� �

Annexure 2: Facility assessment format

2.1 Sadar Hospital

Inspection format for health facilities

Name of the Consultant : Pradeep Tandan Date & time : 26th April

2010

District: Deoghar Total marks: 125

Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Sadar Hospital

I. Infrastructure

Item MOV Criteria Score

Buildin

g

conditio

n

�� Walls and floor and roof intact 2

�� Electrical wires not exposed 1

!� Electric switch boards not broken 2

�� Electric bulbs in wards / pathways / toilets 2

�� Whitewashed 2

1� Signage boards present 2

�� Rooms not dumped with condemned articles 0

11/14

Conditi

on of

wards

a. Mosquito screens present and devoid of holes 0

b. Condemned articles not stored in the wards 1

c. window glasses not broken 2

d. Door / Screens / Curtains / present for ensuring

privacy of patient

0

3/8

Water

supply

a. Running water available for 24 hours in Labour room /

OT / Toilets

5

b. Purified drinking water available for drinking for 0

5/10

��

� �

patients in OP / IP

Conditi

on of

toilets

a. Doors are not damaged 2

b. Floors are clean 2

c. Basins are not stained 1

d. water taps not damaged, 1

e. pathway is not dirty 2

8/10

Patient

ameniti

es

a. Seating arrangements are present in the OPD area 0

b. Stools or chairs for attendants in the wards present 0

c. Inpatients are provided with blankets in winter 0

0/3

Furnitur

e

�� Cots are not rusted not broken 0

�� Mattress not worn out, cloth not torn cotton/coir not

coming out

0

!� Labour board not rusted, not broken, not stained with

blood

0

0/3

II. Human Resource (Self improvement score)

Staff performance

(monthly figure )

Baseline data (1st

survey)

Subsequent visit

*

% improvement

Number of deliveries conducted per SBA NA

Number of OP cases per doctor NA

Bed occupancy rate* NA

Number of CS per Obstetrician NA

Number of cataract operations per

ophthalmologist

NA

Chest symptomatic sputum population

examination rate

NA

Minor surgeries per doctor NA

��

� �

Antenatal care severely anaemic (under 7

gm%) managed rate

Not Available

IUD insertions per trained nurse NA

MTP services per trained doctor NA

o Indicative column; subsequent visits (2nd, 3rd etc. Would be scored on

improvement and in a fresh inspection form)

o Bed occupancy rate=(inpatient days of care/bed days available)×100

III. Services available (applicable for BPHCs and above)

Sl.no Service Means of verification Score

1. 24 hour doctor

available

1 Duty roster, casuality register

11/16

2. 24 hour nurse available 1 Duty roster, casuality register

3. 24 hour delivery

services available

1 Delivery register

4. 24 hour newborn care

services available

0 Delivery register, Paediatric ward register,

Immunization register

5. 24 hour caesarean

services (if FRU)

1 Delivery register

6. Tubectomy services

available

1 FP register

7. Safe abortion services

available

1 MTP register

��

� �

8. 24 hour blood

transfusion services

1 Blood transfusion register / Blood bank

master register

9. Laboratory Services

1. Haemogram

2. Sputum

Examination

3. Lipid Profile

4. Hormone Assay

5. Urine

Examination

2 Equipments and reagents for conducting the

tests are present, lab record shows tests are

conducted

Lab register

10. Availability of ECG

Facility

1 ECG machine available & working

11. X Ray Facility available 1 X ray register – working status

12. Ultrasound services

available

0 USG register – working status

13. Adolescent sexual and

reproductive health

services

0 OP register – number of adolescent

beneficiaries

14. Functional telephone 0 Telephone number with dial tone

15. Whether fixed day

antenatal clinics are

conducted

0 ANC register

IV. Services Out-Sourced

Sl.

no

Item Means of verification Score

1. House

keeping

�� Floor is cleaned with disinfectant on the day of visit 1

��

� �

�� rainbow linen colour maintained 1

!� OT fumigated 1

8/8

2. Generator �� Generator in working condition with designated

horse power

1

�� Fuel for operation present 1

3. Food �� Food served to inpatients 1

�� Food chart for inpatients 1

4. Ambulance Records of operation [Number of ambulances, average (if more than

one ambulance) number of breakdowns in the last one week, number

of drivers available per shift] maintained (1 )

V) Equipments and supplies

Item MOV condition Score

Trolley �� In working

condition

1

�� Trolley without

rust

1

2/6

Wheelchair �� In working

condition

0

��Wheelchair

without rust

0

Stretcher �� Stretcher without

rust

0

�� not broken 0

��

� �

Sterilised gloves �� Sterilised gloves

available

1

1/1

Average number of

OP drugs available

(monthly)

�� Drug stock

register

6

6/10

Availability of life

saving drugs

present

Availability of;

�� Oxytocin 1

�� Misoprostol 1

!� Magnesium

Sulphate

1

�� IV antibiotics 1

4/4

VI. Equipments in Labour room

Equipment MOV Score

�� Spot light in labour room 0

5/7

�� Vacuum extractor 1

!� Resuscitation equipment for newborn – Bag

and mask

1

�� Resuscitation equipment for newborn –

Laryngoscope and full set of endo-tracheal

tubes

0

�� Baby resuscitation table with infant warmer 1

1� g. Mucous sucker 1

�� h. Baby weighing machine 1

VII)Equipment in OT

��

� �

Equipments MOV score

�� Ceiling OT light/ Floor OT

light (shadowless)

1 5/6

�� Oxygen cylinder 1

!� Boyles apparatus (only

FRU)

0

�� Suction apparatus 1

�� Adequate quantity of linen 1

1� Spinal anaesthesia set

(FRU)

1

VIII)Bio-medical Waste Management

Item MOV Score

Waste

management

�� Colour coded buckets

used

0

�� Deep burial pit available

where anatomical waste is

disposed

0

!� Needle cutter in working

condition

1

�� no mix of infectious or

non-infectious waste done

0

�� waste bins not overfilled 1

1� needles and syringes

mutilated and disinfected

before putting in waste

bin

0

�� metal sharps disposed in

puncture proof containers

0

3/8

��

� �

"� disposable gloves and

masks not reused

1`

IX) Central sterilization unit

MOV Score

Autoclave �� Functioning autoclave 1

�� Usage of signalac tape 0

!� usage of biological

indicator

0

�� swab test of sterile

packs

0

1

Item MOV score

a. Separate column (in delivery register) for recording

major complications leading to maternal death 0

0

��

� �

X) Records and reports

XI) Janani Suraksha Yojana

Balance amount

available

Number of mothers yet to

receive the JSY money

Score

Register available All from April 5 marks if all backlog payments are cleared

and current payments are up to date

Appendix 1

Inspection scoring sheet for health facilities

b. Delivery register mentions about the details of the baby

and condition of the mother 1

2 4/6

c. Referral slips are issued to patients 1 2

��

� �

Name of the inspecting officer: Pradeep Tandan Date & time: 26th April

2010


Name of Facility (APHC/BPHC /Referral/ SD/Sadar): Sadar

Item Maximum

marks

Facility

Score

I. Infrastructure 48 27

II. Human Resource Self improvement score

III. Services available (applicable for BPHCs

and above)

16 11

IV. Services Out-Sourced 8 8

V) Equipments and supplies 18 13

VI)Equipments in Labour room 7 5

VII)Equipments in OT 6 5

VIII) Bio-medical Waste Management 8 3

IX) Central sterilization unit 2 1

X) Records and reports 6 4

XI) Janani Suraksha Yojana 5 5

Total Score 125 82

��

� �

2.2 Sarwan Hospital


Name of the Consultant : Pradeep Tandan Date & time : 26 th April

2010


Name of Facility (APHC/BPHC /Referral/ SD/Sadar): BPHC Sarwan

II. Infrastructure


Building

condition

"� Walls and floor and roof intact 2


2� Electric switch boards not broken 1

3� Electric bulbs in wards / pathways / toilets 1

%� Whitewashed 2

& � Signage boards present 0


5/14

Conditio

n of

wards

e. Mosquito screens present and devoid of holes 0

f. Condemned articles not stored in the wards 1

g. window glasses not broken 1

h. Door / Screens / Curtains / present for ensuring

privacy of patient

0

2/8

��

� �

Water

supply

c. Running water available for 24 hours in Labour room /

OT / Toilets

5

d. Purified drinking water available for drinking for

patients in OP / IP

0

5/10

Conditio

n of

toilets

f. Doors are not damaged 1

g. Floors are clean 0

h. Basins are not stained 1

i. water taps not damaged, 1

j. pathway is not dirty 1

4/10

Patient

amenities

d. Seating arrangements are present in the OPD area 1

e. Stools or chairs for attendants in the wards present 0

f. Inpatients are provided with blankets in winter 0

0/3

Furniture �� Cots are not rusted not broken 0


coming out

0

1� Labour board not rusted, not broken, not stained with

blood

0

0/3

( New building is in construction phase)

III. Human Resource (Self improvement score)

Staff performance

(monthly figure )

Baseline data (1st

survey)

Subsequent visit

*

% improvement






ophthalmologist

NA

Chest symptomatic sputum population NA

��

� �

examination rate


Antenatal care severely anaemic (under 7 gm%)

managed rate

Not Available






IV. Services available (applicable for BPHCs and above)


1. 24 hour doctor available 1 Duty roster, casuality register

8/16


3. 24 hour delivery services

available

1 Delivery register


services available



5. 24 hour caesarean 0 Delivery register

��

� �

services (if FRU)


available

1 FP register


available

0 MTP register

8. 24 hour blood transfusion

services

0 Blood transfusion register / Blood bank master

register


6. Haemogram

7. Sputum

Examination

8. Lipid Profile

9. Hormone Assay

10. Urine Examination



conducted

Lab register


Facility




available



reproductive health

services


beneficiaries




conducted

0 ANC register

V. Services Out-Sourced

��

� �

Sl.

no


1. House

keeping



1� OT fumigated 1

5/8

2. Generator !� Generator in working condition with designated horse

power

1

�� Fuel for operation present 1

3. Food !� Food served to inpatients 0

�� Food chart for inpatients 0

4. Ambulance Records of operation [Number of ambulances, average (if more than one

ambulance) number of breakdowns in the last one week, number of

drivers available per shift] maintained (1 )



Trolley !� In working

condition

1/2

�� Trolley without

rust

1/2

2/3

Wheelchair !� In working

condition

0

�� Wheelchair

without rust

0

��

� �

Stretcher !� Stretcher without

rust

1/2

�� not broken 1/2


available

1

1/1

Average number of

OP drugs available

(monthly)

�� Drug stock register 7

7/10


saving drugs present

Availability of;

�� Oxytocin 1

1� Misoprostol 1

�� Magnesium

Sulphate

1

"� IV antibiotics 1

4/4

VII. Equipments in Labour room

Equipment MOV Score

"� Spot light in labour room 0

4/7


2� Resuscitation equipment for newborn – Bag

and mask

1

3� Resuscitation equipment for newborn –


tubes

0

%� Baby resuscitation table with infant warmer 0

& � g. Mucous sucker 1


��

� �

VII)Equipment in OT



light (shadowless)

0 3/6

"� Oxygen cylinder 1

�� Boyles apparatus (only FRU) 0

2� Suction apparatus 1

3� Adequate quantity of linen 1

%� Spinal anaesthesia set (FRU) 0


Item MOV Score

Waste management �� Colour coded buckets

used

0

2� Deep burial pit available


disposed

0

3� Needle cutter in working

condition

1

4/8

��

� �

%� no mix of infectious or


0

& � waste bins not overfilled 0

�� needles and syringes



bin

1

(� metal sharps disposed in


0

$� disposable gloves and

masks not reused

1`


MOV Score


1� Usage of signalac tape 0

�� usage of biological

indicator

0

"� swab test of sterile

packs

0

1

Item MOV score

d. Separate column (in delivery register) for recording 0

��

� �



Balance amount

available



Score

Register available Up to March 5 marks if all backlog payments are cleared


Appendix 2



2010


Name of Facility (APHC/BPHC /Referral/ SD/Sadar): BPHC Sarwan

Item Maximum

marks

Facility

Score


4/6 e. Delivery register mentions about the details of the baby


2

f. Referral slips are issued to patients 1 2

��

� �

II. Infrastructure 48 16

III. Human Resource Self improvement score

IV. Services available (applicable for BPHCs

and above)

16 8

V. Services Out-Sourced 8 5








Total Score 125 64

2.3 Sarath Hospital


Name of the Consultant : Pradeep Tandan Date & time : 26 th April 2010

��

� �


Name of Facility (APHC/BPHC /Referral/ SD/Sadar): BPHC Sarath

III. Infrastructure


Building

condition

(� Walls and floor and roof intact 2

$� Electrical wires not exposed 0

4� Electric switch boards not broken 0



�� Signage boards present 0


5/14

Conditio

n of

wards

i. Mosquito screens present and devoid of holes 0

j. Condemned articles not stored in the wards 1

k. window glasses not broken 1

l. Door / Screens / Curtains / present for ensuring

privacy of patient

0

2/8

Water

supply

e. Running water available for 24 hours in Labour room /

OT / Toilets

5

f. Purified drinking water available for drinking for

patients in OP / IP

0

5/10

Conditio

n of

toilets

k. Doors are not damaged 1

l. Floors are clean 0

m. Basins are not stained 1

n. water taps not damaged, 1

o. pathway is not dirty 1

4/10

Patient

amenities

g. Seating arrangements are present in the OPD area 0

h. Stools or chairs for attendants in the wards present 0

i. Inpatients are provided with blankets in winter 0

0/3

��

� �

Furniture �� Cots are not rusted not broken 0

"� Mattress not worn out, cloth not torn cotton/coir not

coming out

0

�� Labour board not rusted, not broken, not stained with

blood

0

0/3


IV. Human Resource (Self improvement score)

Staff performance

(monthly figure )

Baseline data (1st

survey)

Subsequent visit

*

% improvement






ophthalmologist

NA


examination rate

NA



managed rate

Not Available






��

� �

V. Services available (applicable for BPHCs and above)



7/16



available

1 Delivery register


services available




services (if FRU)

0 Delivery register


available

1 FP register


available

0 MTP register


services


register


11. Haemogram

12. Sputum

Examination

13. Lipid Profile

14. Hormone Assay




conducted

Lab register


Facility


��

� �



available



reproductive health

services


beneficiaries




conducted

0 ANC register

VI. Services Out-Sourced

Sl.

no


1. House

keeping


"� rainbow linen colour maintained 0

�� OT fumigated 0

4/8

2. Generator �� Generator in working condition with designated horse

power

1

1� Fuel for operation present 1


1� Food chart for inpatients 0



��

� �





condition

1/2

1� Trolley without

rust

1/2

2/3


condition

0

1� Wheelchair

without rust

0


rust

1/2

1� not broken 1/2

Sterilised gloves !� Sterilised gloves

available

1

1/1

Average number of

OP drugs available

(monthly)

!� Drug stock register 5

5/10



Availability of;

�� Oxytocin 1

2� Misoprostol 1

3� Magnesium

Sulphate

1

4/4

��

� �

%� IV antibiotics 1

VIII. Equipments in Labour room

Equipment MOV Score

(� Spot light in labour room 0

4/7

$� Vacuum extractor 1

4� Resuscitation equipment for newborn – Bag

and mask

1



tubes

0


�� g. Mucous sucker 1


VII)Equipment in OT


& � Ceiling OT light/ Floor OT

light (shadowless)

0 3/6


(� Boyles apparatus (only FRU) 0

$� Suction apparatus 1

4� Adequate quantity of linen 1

�� Spinal anaesthesia set (FRU) 0

��

� �


Item MOV Score

Waste management 4� Colour coded buckets

used

0

�� Deep burial pit available


disposed

0

�� Needle cutter in working

condition

1



0

�� waste bins not overfilled 0

*� needles and syringes



bin

0

. � metal sharps disposed in


0

�� disposable gloves and

masks not reused

1`

2/8


��

� �

MOV Score


2� Usage of signalac tape 0

3� usage of biological

indicator

0

%� swab test of sterile

packs

0

1



Balance amount

available



Score



Item MOV score

g. Separate column (in delivery register) for recording


0

4/6 h. Delivery register mentions about the details of the baby


2

i. Referral slips are issued to patients 1 2

��

� �

Appendix 3



2010


Name of Facility (APHC/BPHC /Referral/ SD/Sadar): BPHC Sarat

Item Maximum

marks

Facility

Score

III. Infrastructure 48 16

IV. Human Resource Self improvement score

V. Services available (applicable for BPHCs

and above)

16 7

VI. Services Out-Sourced 8 4

��

� �








Total Score 125 58

2.4 Palajori Hospital



��

� �


Name of Facility (APHC/BPHC /Referral/ SD/Sadar): BPHC Palajori

IV. Infrastructure


Building

condition

*� Walls and floor and roof intact 2

. � Electrical wires not exposed 2

�� Electric switch boards not broken 1


5� Whitewashed 2

�� Signage boards present 0


8/14

Conditio

n of

wards

m. Mosquito screens present and devoid of holes 0

n. Condemned articles not stored in the wards 1

o. window glasses not broken 1

p. Door / Screens / Curtains / present for ensuring

privacy of patient

2

4/8

Water

supply

g. Running water available for 24 hours in Labour room /

OT / Toilets

5

h. Purified drinking water available for drinking for

patients in OP / IP

0

5/10

Conditio

n of

toilets

p. Doors are not damaged 1

q. Floors are clean 1

r. Basins are not stained 1

s. water taps not damaged, 1

t. pathway is not dirty 1

5/10

Patient

amenities

j. Seating arrangements are present in the OPD area 0

k. Stools or chairs for attendants in the wards present 0

l. Inpatients are provided with blankets in winter 0

0/3

��

� �

Furniture 2� Cots are not rusted not broken 0

3� Mattress not worn out, cloth not torn cotton/coir not

coming out

0

%� Labour board not rusted, not broken, not stained with

blood

0

0/3


V. Human Resource (Self improvement score)

Staff performance

(monthly figure )

Baseline data (1st

survey)

Subsequent visit

*

% improvement






ophthalmologist

NA


examination rate

NA



managed rate

Not Available






��

� �

VI. Services available (applicable for BPHCs and above)



7/16



available

1 Delivery register


services available




services (if FRU)

0 Delivery register


available

1 FP register


available

0 MTP register


services


register


16. Haemogram

17. Sputum

Examination

18. Lipid Profile

19. Hormone Assay




conducted

Lab register


Facility


��

� �



available



reproductive health

services


beneficiaries




conducted

0 ANC register

VII. Services Out-Sourced

Sl.

no


1. House

keeping

2� Floor is cleaned with disinfectant on the day of visit 1

3� rainbow linen colour maintained 0

%� OT fumigated 0

4/8


power

1

"� Fuel for operation present 1


"� Food chart for inpatients 0


��

� �






condition

1/2

"� Trolley without

rust

1/2

2/3


condition

0

"� Wheelchair

without rust

0


rust

1/2

"� not broken 1/2


available

1

1/1

Average number of

OP drugs available

(monthly)


8/10



Availability of;

& � Oxytocin 1


(� Magnesium

Sulphate

1

4/4

��

� �

$� IV antibiotics 1

IX. Equipments in Labour room

Equipment MOV Score

*� Spot light in labour room 0

4/7

. � Vacuum extractor 1

�� Resuscitation equipment for newborn – Bag

and mask

1



tubes

0

5� Baby resuscitation table with infant warmer 0

�� g. Mucous sucker 1


VII)Equipment in OT



light (shadowless)

1 4/6



*� Suction apparatus 1

. � Adequate quantity of linen 1


��

� �


Item MOV Score


used

0

5� Deep burial pit available


disposed

1


condition

1



0

!!� waste bins not overfilled 1

�� needles and syringes



bin

0

�� metal sharps disposed in


0

11� disposable gloves and

masks not reused

1`

4/8


��

� �

MOV Score

Autoclave & � Functioning autoclave 1


(� usage of biological

indicator

0

$� swab test of sterile

packs

0

1



Balance amount

available



Score



Item MOV score

j. Separate column (in delivery register) for recording


0

4/6 k. Delivery register mentions about the details of the baby


2

l. Referral slips are issued to patients 1 2

��

� �

Appendix 4



2010

��

� �


Name of Facility (APHC/BPHC /Referral/ SD/Sadar): BPHC Palajori

Item Maximum

marks

Facility

Score

IV. Infrastructure 48 22

V. Human Resource Self improvement score

VI. Services available (applicable for BPHCs

and above)

16 7

VII. Services Out-Sourced 8 4








Total Score 125 69

��

� �

2.5 Jasidih Hospital




Name of Facility (APHC/BPHC /Referral/ SD/Sadar): BPHC Jasidih

V. Infrastructure


Building

condition

!!� Walls and floor and roof intact 1


�� Electric switch boards not broken 1

11� Electric bulbs in wards / pathways / toilets 0


""� Signage boards present 0


5/14

Conditio

n of

wards

q. Mosquito screens present and devoid of holes 0

r. Condemned articles not stored in the wards 1

s. window glasses not broken 1

t. Door / Screens / Curtains / present for ensuring

privacy of patient

0

2/8

Water

supply

i. Running water available for 24 hours in Labour room /

OT / Toilets

0

j. Purified drinking water available for drinking for

patients in OP / IP

0

0/10

Conditio

n of

toilets

u. Doors are not damaged 1

v. Floors are clean 0

w. Basins are not stained 1

3/10

��

� �

x. water taps not damaged, 1

y. pathway is not dirty 0

Patient

amenities

m. Seating arrangements are present in the OPD area 0

n. Stools or chairs for attendants in the wards present 0

o. Inpatients are provided with blankets in winter 0

0/3

Furniture & � Cots are not rusted not broken 0


coming out

0

(� Labour board not rusted, not broken, not stained with

blood

0

0/3


VI. Human Resource (Self improvement score)

Staff performance

(monthly figure )

Baseline data (1st

survey)

Subsequent visit

*

% improvement






ophthalmologist

NA


examination rate

NA



managed rate

Not Available



��

� �




VII. Services available (applicable for BPHCs and above)



6/16



available

1 Delivery register


services available




services (if FRU)

0 Delivery register


available

1 FP register


available

0 MTP register


services


register


21. Haemogram

22. Sputum



conducted

��

� �

Examination

23. Lipid Profile

24. Hormone Assay


Lab register


Facility




available



reproductive health

services


beneficiaries




conducted

0 ANC register

VIII. Services Out-Sourced

Sl.

no


1. House

keeping

& � Floor is cleaned with disinfectant on the day of visit 0


(� OT fumigated 0

2/8


power

1

�

� �

2� Fuel for operation present 1


2� Food chart for inpatients 0







condition

1/2

2� Trolley without

rust

1/2

1/3


condition

0

2� Wheelchair

without rust

0


rust

2� not broken


available

1

1/1

Average number of

OP drugs available

(monthly)


6/10

��

� �



Availability of;

4� Oxytocin 1


�� Magnesium

Sulphate

1

�� IV antibiotics 1

4/4

X. Equipments in Labour room

Equipment MOV Score

!!� Spot light in labour room 0

4/7


�� Resuscitation equipment for newborn – Bag

and mask

1

11� Resuscitation equipment for newborn –


tubes

0


""� g. Mucous sucker 1


VII)Equipment in OT



light (shadowless)

0 3/6

��

� �

5� Oxygen cylinder 1


�� Suction apparatus 1

!!� Adequate quantity of linen 1



Item MOV Score


used

0

""� Deep burial pit available


disposed

0


condition

1

22� no mix of infectious or


0

33� waste bins not overfilled 0

%%� needles and syringes



bin

0

2/8

��

� �

& & � metal sharps disposed in


0

�� disposable gloves and

masks not reused

1`


MOV Score

Autoclave 4� Functioning autoclave 1


�� usage of biological

indicator

0

�� swab test of sterile

packs

0

1



Item MOV score

m. Separate column (in delivery register) for recording


0

4/6 n. Delivery register mentions about the details of the baby


2

o. Referral slips are issued to patients 1 2

��

� �

Balance amount

available



Score



Appendix 5



2010


Name of Facility (APHC/BPHC /Referral/ SD/Sadar): BPHC Jasidih

Item Maximum

marks

Facility

Score

V. Infrastructure 48 10

VI. Human Resource Self improvement score

VII. Services available (applicable for BPHCs

and above)

16 6

VIII. Services Out-Sourced 8 2





��

� �




Total Score 125 47

�

� �

Annexure 3: District Profile

Sl. No. Parameter

Census year

1991 2001

T R U T R U

1 Population : Persons 933113 807954 125159 1165390 1005539 159851

Males 488229 419914 68315 608878 522198 86680

Females 444884 388040 56844 556512 483341 73171

2 Decadal growth rate : 31.64 24.89

3 Density : 376 470

4 Sex ratio (TotalPopulation) : 911 924 832 914 926 844

5 Sex ratio ( 0 - 6 Population) : 987 997 902 973 980 910

6 Percentage of 0-6 Population : Persons 21.63 22.35 17.00 19.54 20.42 14.00

Males 20.81 21.53 16.38 18.96 19.87 13.52

Females 22.54 23.24 17.75 20.18 21.03 14.57

7 Percentage of Urban Population : 13.41 13.72

8 Literacy rate : Persons 37.92 32.11 73.00 50.09 44.55 82.33

Males 54.12 49.19 82.52 66.38 62.22 89.62

Females 19.74 13.20 61.37 31.99 25.18 73.59

9 Percentage of Main Workers : Persons 29.46 30.29 24.06 24.34 24.55 23.08

Males 48.60 49.73 41.65 39.49 39.54 39.20

Females 8.45 9.27 2.92 7.78 8.35 3.98

10 Percentage of Marginal Persons 5.42 6.20 0.41 12.79 14.45 2.32

Workers : Males 0.73 0.81 0.27 9.82 10.96 2.98

Females 10.56 12.03 0.58 16.03 18.22 1.54

11 Percentage of Non Workers : Persons 65.12 63.51 75.53 62.87 61.00 74.60

Males 50.67 49.46 58.08 50.69 49.51 57.82

Females 80.98 78.71 96.50 76.20 73.43 94.48

12 Percentage of SC Population : Persons 12.40 13.02 8.41 12.60 13.30 8.20

��

� �

Males 12.34 13.02 8.16 12.53 13.28 8.06

Females 12.46 13.01 8.72 12.68 13.33 8.37

13 Percentage of ST Population : Persons 12.76 14.40 2.17 12.25 13.87 2.05

Males 12.48 14.14 2.29 11.95 13.59 2.10

Females 13.07 14.69 2.03 12.57 14.17 1.99

1991 Census 2001 Census

Area in Sq. Km

2479

No. of Subdivisions

2

No. of C.D.Blocks 7 8

No. of Villages

(a) Total 2704 2706

(b) Inhabited 2327 2356

(c) Uninhabited 377 350

No. of UA's 1 1

No. of Statutory Towns 3 3

Most populous village in the district

Rohini 5991

Least populous village in the district

Durgapur 1

Most populous C.D.Block

Deoghar 256063

Least populous C.D.Block

Devipur 84658

C.D Block having highest literacy rate

��

� �

Total

Deoghar 66.50

Female

Deoghar 51.52

C.D Block having lowest literacy rate

Total

Devipur 39.75

Female

Devipur 20.11

Town having highest literacy rate

Total

Deoghar (M) 86.63

Female

Deoghar (M) 79.28

Town having lowest literacy rate

Total

Madhupur (M) 74.93

Female

Jasidih (NA) 64.23

��

� �

Annexure 4 : Human resources in Deoghar District.

��

��

!��!� ��"�� #� ��#� ��#�

��

��

��

��

!� "��#$�#%��

�� &��

'� � �(�� '� ��

�� )� *�� '� ��

+� ,�-��-�*��

�� ."./0��10� ��

�� 0 ��

�� )�� &��

�� 2�-��#0� �� !� �'�

�� +� ��

�!� ��3��

�� 4.(� �55655� ��

�'� ��.��&��$7�8�� '� ��

�� 6/��7��$7�8� � ��

�+� ��.��&��

�� .9�� '� ��

�� #$�#%�� !� ��

�� -��&��#$�� '� �+�

�� #$:;<��

�� -��&��#$��=��

�!� #$�#%��<�� !�

�� >1�� $��%� � ��

�'� �� #$��=�� !� ��

�� =�� !� ��

�+� 4.1?�� '� !� ��

�� #$��=��@-&.��A� �!� �� !�

��

� �

�� #$��

�� (�� '� �� '�

��

��

�!� ��-�" ��.$� � ��

�� 1?��.��

�'� #$�#%��

�� " ��&��

�+� � �� " ��$7�8� � �� !� ��

�� 4.1?��.9 ��=��

�� 2�B�&.��

�� 0 ��#-%��

�� &� � �� +� ��

�� >1��.$� � �!� �� !�

�!� -��&��.�$� �� !� '� ��

�� .$� ��C�*DE��

�'� C�*DE��

�� 9��

�+� ��.B��

!�� .��&� �!� +� ��

!�� /��&��

!�� -�& � ��

!�� F��.&E��.$� � �� !� ��

�

��

� �

��

� �

��

� �

��

� �

��

� �

Documents

Action oriented monitoring report Deoghar District Jharkhand